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USE OF TIMOLOL IN PREGNANCY

Date of issue: July 2024, Version: 4

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A corresponding patient information leaflet on USE OF TIMOLOL IN PREGNANCY is available.

Timolol is a non-selective beta-blocker licensed for the treatment of hypertension, angina, prophylactic treatment of migraine, and to reduce mortality and reinfarction in patients surviving acute myocardial infarction. It is also used topically (ophthalmically) in open-angle glaucoma and ocular hypertension.

Data on timolol use in pregnancy are limited and relate primarily to topical use. Fetal bradycardia has been documented in a single case report of topical use but a causal association was not proven. The limited available data to do not raise concern of other fetal risks but are too limited to formally rule this out. However, topical use as per the manufacturer’s instructions is considered unlikely to result in systemic concentrations that could cause fetal harm. When use in pregnancy is being considered, the benefits (including preventing permanent vision loss) should be weighed against any theoretical risks to the fetus.

Systemic use of beta-blockers in pregnancy has been associated with adverse effects on fetal growth, although because maternal hypertension is linked to IUGR, analysis is complex and any contribution of beta-blocker exposure to this outcome remains unquantified. Overall, data do not suggest that gestational beta-blocker exposure increases the risk of congenital malformation or preterm delivery. Data on risks of miscarriage, stillbirth and neurodevelopmental outcomes are too limited to permit a risk assessment.

Use of beta-blockers near term may result in neonatal beta-adrenoceptor blockade, leading to neonatal bradycardia, hypotension, and hypoglycaemia. Respiratory distress has also been reported. Assessment of the neonate for these effects is thus advised. Although no reports of neonatal hypotension or hypoglycaemia following topical use of timolol in pregnancy have been identified in the literature, theoretical concerns may exist. Assessment of the neonate for these effects is thus advised.

Exposure to timolol at any stage in pregnancy would not usually be regarded as medical grounds for termination of pregnancy. Additional monitoring is generally indicated in pregnancies complicated by maternal hypertension, regardless of pharmacotherapy. Additional fetal growth scans should be offered following gestational exposure to beta-blockers. Other risk factors may be present in individual cases which may independently increase the risk of adverse pregnancy outcome. Clinicians are reminded of the importance of consideration of such factors when performing case-specific risk assessments.

This is a summary of the full UKTIS monograph for health care professionals and should not be used in isolation. The full UKTIS monograph and access to any hyperlinked related documents is available to NHS health care professionals who are logged in.

If you have a patient with exposure to a drug or chemical and require assistance in making a patient-specific risk assessment, please telephone UKTIS on 0344 892 0909 to discuss the case with a teratology specialist.

If you would like to report a pregnancy to UKTIS please click here to download our pregnancy reporting form. Please encourage all women to complete an online reporting form.

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